The state's largest health care provider is reexamining its decision about how certain patients with HIV or AIDs pay for their insurance. Blue Cross Blue Shield Louisiana policy holders were alerted last month that the company would not be accepting third party payments for their premiums.
This policy comes after the Centers for Medicare and Medicaid issued an advisory to insurance companies, warning about potential fraud. In the November advisory, CMS advised companies to reject third party payments saying:
"The Department of Health and Human Services has significant concerns with this practice because it could skew the insurance risk pool and create an unlevel field in the Marketplaces. HHS discourages this practice and encourages issuers to reject such third party payments."
However, the move has been seen by some health care experts as yet another frustrating challenge in the process of reforming insurance.
"Our clients have been sort of churned back and forth over the years and while many of them do a very good job with it and work very closely with our case management staff to make sure they have access to medications and medical care, it doesn't mean that it cannot become completely confusing and frustrating," said Case Management Program Director for NO/AIDS Task Force Lucy Cordts.
The BCBS LA decision particularly impacts the HIV/AIDs community because many of those patients use federal funds from the Ryan White Foundation to help pay for medical expenses, and now, health insurance. Cordts says those funds help fill the financial gap left when Louisiana officials opted not to expand Medicaid.
So, in January when Ryan White funds went out to BCBS LA to pay for clients' premiums, the payments were rejected.
However, CMS has now clarified the original advisory. In an email sent to WAFB on Monday, a CMS spokesperson stated:
"Federal rules do not prevent the use of Ryan White funds to pay for health care plans. In fact, CMS issued guidance last week making this clear and encouraging issuers and Marketplaces to accept such payments. Given the importance of access to care for people with HIV/AIDS, CMS is considering amending those the rules to require issuers to accept these payments."
Blue Cross Louisiana spokesperson John Maginnis said the company is reviewing the latest information from CMS.
"We are reviewing and considering this new information to decide whether it is helpful in addressing our concerns about taking third-party payments," wrote Maginnis in an email.
Maginnis went on to write that the company is not denying coverage to anyone, and policies are still available to anyone who wishes to purchase on. He explains that the policy against third party payments applies to every client regardless of their health condition or type of insurance.
Cordts says there are still options out there for any HIV/AIDs patient who need help finding insurance. She suggests reaching out to health care navigators or to the local AIDs resource group for guidance.
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